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Cardiology

Repeatedly Malignant ST-Segment Elevation

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JAMA Internal Medicine

Published Online: November 20, 2023

Challenges in Clinical Electrocardiography

Article Information and Disclosures

YaoYuan Xiao, MD¹;

MingXiang Tang, MD²;

Author Affiliations

¹Department of Cardiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Normal University, Changsha, China
²Department of Cardiology, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Normal University, Changsha, China

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A male patient in their early 50s with no history of prior known diseases was admitted to the hepatobiliary surgery unit with epigastric pain and jaundice of 2 weeks. Electrocardiogram (ECG) findings at admission were normal. On the third day of admission, the patient experienced a sudden squeezing pain in the anterior chest at rest, with a heart rate of 44 beats/min, blood pressure of 97/60 mm Hg, and oxygen saturation of 98%. The ECG (Figure, A) showed troponin I level of 0.107 ng/mL (normal reference value, 0 to approximately 0.034 ng/mL; to convert to micrograms per liter, multiply by 1). Isoproterenol was immediately administered by intravenous infusion due to a significantly decreased heart rate. About 20 minutes later, the patient reported that the pain was relieved, and a repeat ECG was done (Figure, B).

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A male patient in their early 50s with no history of prior known diseases was admitted to the hepatobiliary surgery unit with epigastric pain and jaundice of 2 weeks. Electrocardiogram (ECG) findings at admission were normal. On the third day of admission, the patient experienced a sudden squeezing pain in the anterior chest at rest, with a heart rate of 44 beats/min, blood pressure of 97/60 mm Hg, and oxygen saturation of 98%. The ECG (Figure, A) showed troponin I level of 0.107 ng/mL (normal reference value, 0 to approximately 0.034 ng/mL; to convert to micrograms per liter, multiply by 1). Isoproterenol was immediately administered by intravenous infusion due to a significantly decreased heart rate. About 20 minutes later, the patient reported that the pain was relieved, and a repeat ECG was done (Figure, B).

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Article Information

Corresponding Author: Yi Tang, PhD, Department of Cardiology, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Normal University, Changsha 410005, China (da123zhiruoyu@163.com).

Published Online: November 20, 2023. doi:10.1001/jamainternmed.2023.4841

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank Xiaohui Duan, PhD, from Hunan Provincial People’s Hospital for providing part data of the patient; compensation was not received.

References

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AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.